Antifungal drugs: An updated review of central nervous system pharmacokinetics

Wirth, Fernanda; Ishida, Kelly

doi:10.1111/myc.13157

Cited by 14 publications

(7 citation statements)

References 176 publications

(379 reference statements)

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“…While fluconazole exhibits lesser antifungal activity against S. schenckii compared to itraconazole, its penetration into CNS is significantly greater. 46 Early recognition of this disease may reduce its elevated mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to note that not all antifungal agents effectively penetrate the blood–brain barrier. While fluconazole exhibits lesser antifungal activity against S. schenckii compared to itraconazole, its penetration into CNS is significantly greater 46 . Future research should focus on comparing different azole antifungals for the treatment of CNS sporotrichosis.…”

Section: Discussionmentioning

confidence: 99%

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Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta‐analysis

de Oliveira,

Petrucci,

Taborda

et al. 2024

Mycoses

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BackgroundThe clinical features of central nervous system (CNS) sporotrichosis are derived from case reports and a limited series of cases. Our objective was to carry out a systematic review and meta‐analysis of CNS sporotrichosis.MethodsWe searched PubMed/MEDLINE, Embase, Scopus, and LILACS on 9 September 2023. Our inclusion criteria were documentation of Sporothrix and demonstrated CNS involvement. A metaproportion or metamean analysis was performed to estimate a summary proportion with 95% confidence intervals.ResultsWe included 52 cases of CNS sporotrichosis published from 1966 to 2023. Forty‐six patients were male (88%, 95% CI: 77–95), and the mean age was 39 years (95% CI: 36–43). Close contact with cats was reported in 55% of cases (95% CI: 37–72). Thirty‐two (61.5%) patients were from Brazil, 18 patients from the United State of America (34.6%). Only two Sporothrix species were reported: S. schenckii (26/41, 63%), and S. brasiliensis (15/41, 37%). The most common neurological symptom was headache. Meningitis was chronic in approximately 80% of cases. A significant majority of the patients were immunocompromised. HIV infection was the primary cause of immunosuppression (85%, 95% CI: 61–95). Overall mortality was 56% (22/39). The comparison of Kaplan–Meier survival curve showed a higher mortality with a statistically significant difference in immunosuppressed patients (p = .019).ConclusionCNS sporotrichosis represents a notable cause of chronic meningitis, especially in individuals living in the Americas with HIV infection and concurrent skin lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta‐analysis

de Oliveira,

Petrucci,

Taborda

et al. 2024

Mycoses

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“…В свя зи с этим при неэффективности 1й линии терапии необходима смена класса препарата с учетом его спек тра действия. Также при наличии неврологической симптоматики необходимо делать выбор в пользу пре парата, способного проникать через гематоэнцефали ческий барьер, -полиенов или при подтвержденной чувствительности азолов [71].…”

Section: превентивная терапияunclassified

Benefits of early antifungal therapy in hematology patients

Andreev,

Bronin,

Epifanova

et al. 2024

Onkogematologiâ

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Invasive fungal infections (IFIs) are a serious threat to patients with hematological diseases. These infections are characterized by high mortality and lead to significant financial costs for treatment. The most common pathogens of IFIs are Aspergillus spp. and Candida spp., but in recent years, cases of infections caused by rare pathogens have become more frequent. Diagnosis of IFIs and choice of treatment remain challenging due to the nonspecificity of symptoms and the diversity of clinical cases. In this regard, the problem of start time and choice of antifungal therapy remains of current interest. This review briefly describes diagnostic criteria, challenges associated with IFIs diagnosing, provides evidence for empiric and preventive strategies as two early treatment approaches, and examines the impact of therapy initiation on patient outcomes. Treatment of IFIs in hematologic patients should be individualized. At the same time, early administration of therapy with broad-spectrum drugs for febrile neutropenia and parallel diagnostic measures can improve treatment outcomes. There is a lack of current data on the benefits of specific treatment strategies, highlighting the need for further research.

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“…Step one: If sepsis or septic shock with candidemia or endophthalmitis is present, because echinocandins do not reach therapeutic concentrations in eyes and the central nervous system [ 106 , 107 ], liposomal amphotericin B should be the option.…”

Section: Analysis Of Potential Alternativesmentioning

confidence: 99%

Critical appraisal beyond clinical guidelines for intraabdominal candidiasis

Maseda,

Martín-Loeches,

Zaragoza

et al. 2023

Crit Care

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Background Regardless of the available antifungals, intraabdominal candidiasis (IAC) mortality continues to be high and represents a challenge for clinicians. Main body This opinion paper discusses alternative antifungal options for treating IAC. This clinical entity should be addressed separately from candidemia due to the peculiarity of the required penetration of antifungals into the peritoneal cavity. Intraabdominal concentrations may be further restricted in critically ill patients where pathophysiological facts alter normal drug distribution. Echinocandins are recommended as first-line treatment in guidelines for invasive candidiasis. However, considering published data, our pharmacodynamic analysis suggests the required increase of doses, postulated by some authors, to attain adequate pharmacokinetic (PK) levels in peritoneal fluid. Given the limited evidence in the literature on PK/PD-based treatments of IAC, an algorithm is proposed to guide antifungal treatment. Liposomal amphotericin B is advocated as first-line therapy in patients with sepsis/septic shock presenting candidemia or endophthalmitis, or with prior exposure to echinocandins and/or fluconazole, or with infections by Candida glabrata. Other situations and alternatives, such as new compounds or combination therapy, are also analysed. Conclusion There is a critical need for more robust clinical trials, studies examining patient heterogeneity and surveillance of antifungal resistance to enhance patient care and optimise treatment outcomes. Such evidence will help refine the existing guidelines and contribute to a more personalised and effective approach to treating this serious medical condition. Meanwhile, it is suggested to broaden the consideration of other options, such as liposomal amphotericin B, as first-line treatment until the results of the fungogram are available and antifungal stewardship could be implemented to prevent the development of resistance.

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Antifungal drugs: An updated review of central nervous system pharmacokinetics

Cited by 14 publications

References 176 publications

Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta‐analysis

Clinical characteristics, diagnosis, and treatment of central nervous system sporotrichosis: Systematic review and meta‐analysis

Benefits of early antifungal therapy in hematology patients

Critical appraisal beyond clinical guidelines for intraabdominal candidiasis

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